Using arts and communication to help physicians improve health, avoid suicide

Physicians are more prone to suicide than members of the general population, as stress, burnout and emotional exhaustion are becoming endemic to the profession. But programs that offer support to physicians, including creative outlets in the arts, peer support groups and programs in writing and communication, can help provide life balance and practical tools to counteract the stresses and sometimes overwhelming demands of today’s medical practice, say two Stanford researchers.

The recent suicides of two former residents at Stanford have focused attention on ways to help doctors manage the pressures of the profession and its high rates of suicide, oncologist Jonathan Berek, MD, and medical humanities scholar Jacqueline Genovese write in the latest issue of the Journal of Clinical Oncology.

Oncologists in particular may be predisposed to burnout, depression and substance abuse because of the nature of their work, in which they often have to deliver distressing news to patients and shepherd them through the process of dying, said Berek, professor and chair of gynecology and obstetrics and director of the Stanford Women’s Cancer Center.

“As an oncologist, I think it’s an important issue because you spend a lot of time breaking bad news, and I have found over the years that the colleagues who deal with it best are the ones with a multifaceted life and who are able to connect with the arts and have many other interests. They deal with the bad news and death and dying much better than others,” he said.

He and Genovese compare physicians in the trenches with battle-ready soldiers, who may internalize demands, suppress feelings of doubt or sorrow and develop emotional detachment as a survival mechanism, which can promote burnout and depression. Like many veterans, physicians may experience post-traumatic stress as a consequence of their day-to-day interactions with patients, they write.

“Doctors and soldiers are not super-human, but we often expect them to be,” Genovese told me. “I tell the doctors, ‘That’s a white coat, not a cape you wear,” because we think of both soldiers and doctors in heroic terms, and that is often an unfair and unrealistic expectation.”

Berek agrees. “Physicians sometimes feel as though they’re dodging bullets, too. They aren’t real, but they feel real. You have a conversation that leaves you feeling that you are walking around emotionally drained. And you may have repeated stressful circumstances that you are dealing with,” he said.

“Plus we all recognize there are more pressures on physicians to see greater numbers of patients more expeditiously. So on top of having to deal with challenging circumstances, there are the exigencies of medical practice. Coping with the challenge of being an enthusiastic supporter of your patient and showing empathy and maintaining that day after day, that is the challenge. I think it’s particularly tough in some of the high-stress professions, like oncology.”

Berek’s focus has been communications, providing a safe space for Stanford physicians to talk about the challenging circumstances they face. Through the Stanford Health Care Communications program and the Advanced MD C.I.Care program, which he directs, faculty and trainees can role-play difficult situations and talk about how to provide an empathetic response, he said.

“As physicians feel they are better communicators, the satisfaction with their job goes up. And that links to wellness. The more satisfied you are that you are successfully communicating with your patients even when you deliver bad news, the better you feel as a physician,” he said. “If you get a sense that you are connecting with your patients, you know you are doing a better job. That leads to better satisfaction and better well-being. That decreases the risk of self-destructive behavior, such as drinking too much, taking drugs and suicide.”

He and Genovese point to a plethora of other programs at Stanford Medicine to provide healthy and creative ways to help improve physician well-being and enable them to care for themselves – and others. These include the Pegasus Physician Writers group in which clinicians can share their work and their emotional lives, and the Stanford Literature and Medicine Program, a dinner and discussion series in which physicians can use literature as a mechanism for discussing the challenges and rewards of their careers. Genovese, who is assistant director of the Medicine & and the Muse Program at Stanford, facilitates the Literature and Medicine program at Stanford with research colleague Benny Gavi, MD, and also teaches a War Literature and Writing seminar for Stanford military-affiliated students.

The Stanford Committee on Physician Satisfaction and Physician Support, formed in part in response to the resident suicides, also sponsors a peer support program – similar to one offered at the Palo Alto Veterans Affairs Health Care System – where physicians can share experiences and address issues related to burnout, depression and PTSD.

Recently, a new Physician Wellness Center also began offering programs on physician mindfulness-based stress reduction and compassion cultivation.

“The long-term strategy is to effect perceptible and measurable changes in the culture of our institution,” Berek and Genovese write. “Our sincere hope is that the programs that are being developed will produce positive documented results, and that the emerging data will support the development of similar activities at other medical institutions.”